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IP - IR - Pre Hepatic Artery Embolization - Adult - Preprocedure [1290]

IP - IR - Pre Hepatic Artery Embolization - Adult - Preprocedure [1290] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Pre Hepatic Artery Embolization - Adult - Preprocedure [1290]
Patient Care Orders
Vital Signs [150344]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [150345]
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, Routine, To
discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes in
the new order.
Type:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Nutrition [100685]
NPO except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
With sips of water.
Non-Categorized Patient Care Orders [100645]
Nursing Communication [NURCOM0022] SEE COMMENTS, Starting today, Procedure to be
performed ***.
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
MD to perform radial artery access. Do NOT
place peripheral IV in region of left wrist or left
hand. [NURCOM0022]
ONCE For 1 Occurrences, MD to perform radial artery
access. Do NOT place peripheral IV in region of left
wrist or left hand.
Diabetes Monitoring [150355]
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT For 7 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Obtain if POC Glucose
is less than 40 or greater than 400 mg/dL.
Contingency Parameters [16918]
Page 1 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:29:32 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 60
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 90
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Aspirin in the last 3 days,Clopidogrel (PLAVIX)
in the last 7 days,Low molecular weight heparin
(LMWH) in the last 12 hours,Unfractionated heparin
for the last 8 hours,metFORMIN (GLUCOPHAGE) for
the morning of procedure,Warfarin (COUMADIN) for
the last 5 days,Platelet count greater than 50,000, INR
less than 1.5
Intravenous Therapy
Premedications for Needle Insertion [124125]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion
- see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Page 2 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:29:32 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
IV Fluids [19391]
dextrose 5%-NaCl 0.45% infusion - NOTE: Infuse
in Line 1 [51613]
at 150 mL/hr, Intravenous, CONTINUOUS
NOTE: Infuse in Line 1
sodium chloride 0.9 % infusion [64367] at 150 mL/hr, Intravenous, CONTINUOUS
Surgical Prophylaxis
First Line [28240]
ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
3 g, Intravenous, ONCE For 1 Doses
Patients with MRSA (Single Response) [151213]
Patients who are greater than 40 kg [228207]
ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
3 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS (Max
dose = 2000 mg) [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [228208]
Patients who are 40-120 kg [230363]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS - Note:
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Patients who are 121 kg and greater [230366]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
750 mg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS - Note:
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Medications
Preprocedure [18054]
Note: Pharmacy: Please tube dexamethasone to
Radiology Prep/Recovery at #434 [950018]
ONCE
dexamethasone (DECADRON) intraVENOUS
[800037]
12 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure
diphenhydramine (BENADRYL) injection 50 mg
[800106]
50 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure
Antiemetics [228213]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
30 minutes prior to procedure
Non-categorized [118037]
lidocaine (STERILE UROJECT) 2 % gel [785049] Urethral, ONCE For 1 Doses
Laboratory
Labs [16896]
Page 3 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:29:32 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

WHITE CELL COUNT [WBC] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEMOGLOBIN [HGB] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GLUCOSE [GLU] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BUN [BUN] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CREATININE [CRET] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALT/SGPT [ALT] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
AST/SGOT [AST] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 4 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:29:32 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

BILIRUBIN, TOTAL [TBIL] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUALITATIVE, URINE [UPREG] STAT - RN COLLECT, Starting tomorrow For 1
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 5 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 8/22/2017 9:29:32 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org